Provider Demographics
NPI:1942840806
Name:NORWOOD, CHARLIE ERIC JR
Entity Type:Individual
Prefix:
First Name:CHARLIE
Middle Name:ERIC
Last Name:NORWOOD
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 ASCOT DR STE D
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3400
Mailing Address - Country:US
Mailing Address - Phone:916-787-1100
Mailing Address - Fax:
Practice Address - Street 1:120 ASCOT DR STE D
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3400
Practice Address - Country:US
Practice Address - Phone:916-787-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-08
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician